Pediatric emergency medicine trisk 4020 4020

Antibiotic choice should be tailored to the pathogen identified by culture.
Surgery should be considered for refractory and progressive infections not
responding to antibiotics. Epidural extension with neurologic compromise
should be treated with emergent decompression and evacuation of the
infection.
Clinical Pitfall. An entity known as chronic recurrent multifocal
osteomyelitis (CRMO), or nonbacterial osteomyelitis (NBO), should be
distinguished from spondylodiscitis or osteomyelitis. It is often associated
with additional inflammatory syndromes, including peripheral arthritis,
sacroiliitis, psoriasis, inflammatory bowel disease or SAPHO (synovitis,
acne, pustulosis, hyperostosis, and osteitis). The etiology is poorly
understood. Young girls are more often affected (5:1) between the ages of 4
to 14 years. Patients are often asymptomatic between episodes, but
symptoms may extend beyond 6 months. Patients may have minor
diagnostic criteria of normal or mildly elevated labs (CRP, ESR),
hyperostosis, other autoimmune diseases, and an associated family history.
Radiographic imaging can mimic osteomyelitis, but other long bones are
typically involved. Bone biopsies are often necessary for diagnosis and
result as sterile but demonstrate evidence of inflammation and/or sclerosis
or fibrosis. Standard therapy involves NSAID use, but alternate medications
such as oral steroids, methotrexate, and bisphosphonates, most commonly
pamidronate, have been reported with positive early results.
Spinal Epidural Abscess
The most common anatomical site for thecal sac encroachment by epidural
abscess is in the cervical spine, followed by the thoracic and lumbar spine.
However, neurologic complications, paraparesis or paraplegia, as a result of
thecal sac compression occurred more frequently in the thoracic and
cervical regions. The most feared complication of primary or secondary
spinal epidural abscess is paralysis. When paraplegia or tetraplegia is
present, the prognosis is very poor.

POSTOPERATIVE COMPLICATIONS
CLINICAL PEARLS AND PITFALLS